Abstract
In order to elucidate the mechanism of developement of gastroduodenal lesions follow-ing transcatheter arterial infusion therapy using lipiodolized MMC (Lp-TAI) for hepatocel-lular carcinoma (HCC), 125 times, endoscopic examinations were performed for 68 cases with HCC, and findings were compared before and just after Lp-TAI therapy. Gastroduodenal ulcers were newly developed in 15 cases, and the incidence of ulcer was 12%. Erosive or hemorrhagic gastritis were developed in 33 cases, the incidence there of being 26.4%. In total, 48 lesions resulted from 125 times of Lp-TAI's, and the incidence reached to 38.4%. Morphological characteristics of the ulcers after the application of Lp-TAI were irregular-shaped whitish exudates and the gastric mucosa around the ulcers showed remarkable redness and edematous change. It was therefore possible to clearly distinguish them from peptic ulcers. Most of the ulcers which had been developed after Lp-TAI were shallow, and all the ulcers were not resistant to ordinary treatments and changed into scars within 3 months. Erosive gastritis usually showed remarkable redness with hemorrhage, and at times were accompanied by small erosions with whitish exudates. Twenty four of 33 cases (72.2%) with erosive gastritis were localized on a part of the stomach. It is well known that gastric mucosal redness and ulcers are frequently complicated by liver cirrhosis. We then divided the patients into some groups by profile, e. g., degree of liver function, portal hypertension and so forth, and compared the groups in incidence. As a result, it was found that the incidence of gastroduodenal lesion developed after Lp-TAI had no correlation with the severity of liver cirrhosis, but was closely related with the number of times Lp-TAI therapy. The more times Lp-TAI was repeated, the higher the incidence was increased. From the view point of the morphological characteristics of the ulcers and the statistical analysis of the incidence of gastroduodenal lesion developed after Lp-TAI, it can be thought that regurgitation of the lipiodol MMC suspension into the gastric arteries played an important role in the development of ulcers after the application of Lp-TAI therapy. Therefore, it is important to insert a catheter as selectively as possible into a peripheral branch of hepatic artery for the prevention of the complications.
